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Federal Constitutional Court in Karlsruhe (archive picture)
Photo: Uli Deck / dpa
The Federal Constitutional Court has set clear limits for the compulsory treatment of patients in the so-called penal system.
Unless other people are at risk, an affected person cannot be treated with medication against his will.
This emerges from a decision published in Karlsruhe on Friday.
(Az. 2 BvR 1866/17 et al.)
In principle, everyone can freely decide on interventions in accordance with the Basic Law.
In connection with human dignity, this results in a "freedom to disease," as the court put it.
Mentally ill or addictive offenders are accommodated in the penal system.
For example, you will be sent to a psychiatric hospital or rehab clinic instead of a prison.
The court dealt with two constitutional complaints from a man from Bavaria who has been in a district hospital since October 2015.
There he was given neuroleptics against his will.
The doctors justified this with his schizophrenia and brain damage, which they wanted to avoid.
Repeated attacks on nurses
In the original case, the man was placed in a psychiatric hospital by a judgment of the Nuremberg-Fürth regional court in January 2017. The reason: In October 2015, as the decision of the Federal Constitutional Court says, he stabbed the chest of a neighbor with a cutlery knife “due to a delusional disorder in a state of incapacity” and tried to kill him. The neighbor suffered only superficial injuries - according to the findings of the Nuremberg-Fürth regional court, however, the man considered the cutlery knife suitable for killing the neighbor, and he wanted to kill him too. According to an expert's opinion, the man suffers from a paranoid life of madness: He saw himself as a victim of an intrigue by secret services, Satanists and Illuminati;he had 28 fathers and had to kill his opponents to defeat evil.
Even after his arrest and temporary placement in a psychiatric ward, he repeatedly assaulted nursing staff.
Even then, a court ordered compulsory treatment, against which the man defended himself with a constitutional complaint.
Such compulsory treatment, decided the Federal Constitutional Court, can in principle be appropriate.
The courts previously dealing with it should have examined this more comprehensively and in more detail.
"Mere standard sentences are not enough"
In this case, the plaintiff had filed a kind of living will in writing in 2005, he issued orders for life-prolonging measures as well as foreign blood transfusions and appointed his mother as an authorized representative.
At the beginning of 2015, he also prohibited the administration of neuroleptics against his will.
The district hospital nevertheless applied for compulsory treatment with neuroleptics in September 2016. The regional court granted permission for this, and in 2017 permission was also granted to extend the administration of medication.
The Karlsruhe lawyer David Schneider-Addae-Mensah asserted on behalf of the man, among other things, that the compulsory treatment here was "disproportionate"; "Mere standard sentences such as endangering health and legal interests are not sufficient," said Schneider-Addae-Mensah in his constitutional complaint. In this regard, "the individual's fundamental right to illness" should also be observed - "a mere aggravation of a possible, but by no means proven, underlying disease is in any case not enough". The health risk from the preparation used is "higher in any case, and above all - in contrast to the possible disease - it is not wanted".
The Federal Constitutional Court now made it clear: "Any medical treatment of a person against their natural will encroaches on the fundamental right to physical integrity."
Forced treatment as a "last resort"
An interference in the basic rights of men could be justified, for example to protect employees or other patients or even him from himself. Compulsory treatment is, however, a »last resort« and may only be used »if milder means are no longer possible and treatment that does not interfere with the basic rights of the person concerned is therefore futile«, according to the judges of the Second Senate in their decision. Further prerequisites are, on the one hand, "that the person concerned is unable to understand due to illness or cannot behave appropriately", and that prior to treatment, "the serious attempt made with the necessary time and without exerting undue pressure" was made, "based on trust to obtain well-founded consent «. On the other hand,that »the expected benefit« of the compulsory treatment »clearly outweighs the possible harm of non-treatment as well as the impairment associated with the measure«. Strict requirements must also be placed on the procedure, such as announcing planned treatments, checking them in advance by independent third parties, and monitoring them by medical staff.
However, if compulsory treatment only serves to protect the basic rights - i.e. above all life and limb - of the person being accommodated, it must be avoided if the patient has effectively excluded it in advance, i.e. in a state of discernment.
Regensburg regional court has to negotiate again
The courts previously dealing with the case - the Nuremberg-Fürth and Regensburg regional courts and the Nuremberg Higher Regional Court - did not consider this point in particular. Although they assumed an effective living will, they had "made the man's statement of January 11, 2015 subordinate to the state duty to protect the complainant's health and, in particular, to make him fit for dismissal." For this reason, they also failed to examine whether the protection of other patients or employees could justify such an encroachment on fundamental rights in a specific case.
With their decision, the Karlsruhe constitutional judges overturned the previous decisions of the Nuremberg-Fürth Regional Court and the Nuremberg Higher Regional Court as well as the Regensburg Regional Court.
Their decision was passed with 7: 1 votes.
The regional court of Regensburg now has to renegotiate the facts.
hip / kha / dpa / AFP